Chrysant Steven G
University of Oklahoma, Oklahoma Cardiovascular and Hypertension Center, 5850 W Wilshire Blvd, Oklahoma City, OK 73132-4904, USA.
Expert Rev Cardiovasc Ther. 2003 Sep;1(3):335-43. doi: 10.1586/14779072.1.3.335.
Hypertension is a major risk factor for cardiovascular morbidity and mortality. Monotherapy of hypertension is often ineffective, since it controls approximately 50% of the blood pressure of hypertensive patients. For lowering blood pressure to less than 140/90 mmHg (or <130/80 mmHg among people with diabetes or chronic renal disease) according to JNC-7 guidelines, combination therapy of two or more drugs is often necessary. The combination of a diuretic with an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) is effective and provides the additional benefit of blocking the effects of angiotensin II, which is responsible for cardiovascular remodeling and its complications. ARBs may have an advantage over the ACEIs because they block the action of all angiotensin II directly, whereas ACEIs are ineffective in blocking angiotensin II generated by nonclassical ACE pathways. Valsartan (Diovan, Novartis) is one of the seven currently approved ARBs in the USA for the treatment of hypertension, and it has been shown to be very effective in controlling blood pressure given once-daily in doses of 80-160 or 320 mg. Its fixed combination with hydrochlorothiazide (HCT) is even more effective in controlling blood pressure in 70% of the cases. The most commonly used combinations are valsartan/HCT (Diovan/HCT), 80/12.5 and 160/12.5 mg given once-daily.
高血压是心血管疾病发病和死亡的主要危险因素。高血压的单一疗法往往无效，因为它只能控制约50%高血压患者的血压。根据美国国立综合癌症网络（JNC）-7指南，为了将血压降至低于140/90 mmHg（糖尿病或慢性肾病患者低于130/80 mmHg），通常需要两种或更多药物的联合治疗。利尿剂与血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）联合有效，且能额外阻断血管紧张素II的作用，血管紧张素II会导致心血管重塑及其并发症。ARB可能比ACEI更具优势，因为它们能直接阻断所有血管紧张素II的作用，而ACEI对非经典ACE途径产生的血管紧张素II无效。缬沙坦（代文，诺华公司）是美国目前批准用于治疗高血压的七种ARB之一，已证明每日一次服用80 - 160或320 mg剂量时，在控制血压方面非常有效。它与氢氯噻嗪（HCT）的固定复方在70%的病例中控制血压效果更佳。最常用的复方制剂是缬沙坦/HCT（代文/HCT），每日一次服用80/12.5和160/12.5 mg。
